Panetti is aware that the state claims that it intends to execute him because he committed two murders. The issue in the case was whether he can be executed if, as some experts assert, he believes that the state's real reason for executing him is to keep him from preaching the gospel.

Panetti has suffered from schizo-affective disorder for years. A mental health professional stated that, as part of his delusion, Panetti believes that his execution is a "part of spiritual warfare."

The Texas state court refused to allow Panetti to offer proof of his mental incompetence. In fact, the state court did not even allow a competency hearing. While denying him his right to a hearing, the court denied all of his motions, including funds for a mental health expert.

Instead, the Texas court stated it would rule on his motions only if the state-appointed mental health experts said that Panetti was unable to understand that he was going to be executed and why. The Supreme Court held that the question of competence must not end there. According to Justice Kennedy's majority opinion, Ford includes a requirement that the condemned person have a rational understanding of why he will be executed. The Court remanded the case back to the District Court for a fair determination of whether Panetti has a rational understanding of why Texas intends to execute him.

Justice Thomas dissented joined by Chief Justice Roberts and Justices Scalia and Alito.